Cardiology Coding Alert

Question: During a nuclear stress test, the patient became claustrophobic and needed to stop. Normally we charge 78452, 93015, A9500x2. We were only able to inject the patient with one dose of A9500. As we started the resting pictures at the beginning of the test, the patient asked to be removed from the camera bed. Are we able to charge anything for this test?

Codify Member

Answer: When reporting stopped services, you first should check whether the payer has any specific guidelines. If the payer doesn’t offer guidance, your goal should be to let the claim show the extent of the services actually performed.

In this case, patient claustrophobia resulted in an incomplete rest study. You may represent this by appending modifier 52 (Reduced services) to 78451 (Myocardial perfusion imaging, tomographic [SPECT] [including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed]; single study, at rest or stress [exercise or pharmacologic]).

To represent the Cardiolite administered, report a single unit of A9500 (Technetium TC-99M sestamibi, diagnostic, per study dose).

Based on the information given, it doesn’t appear that your practice performed any of the services described by 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with supervision, interpretation and report), so you should not report this code.